By: Becca Taurisano
Childbirth is inherently risky, but for minority women, it can be life-threatening. Consider the birth experience of global tennis star Serena Williams. Williams had a history of pulmonary embolism and, while recovering in the hospital after giving birth via c-section, she had difficulty getting her providers to acknowledge her symptoms. After repeatedly advocating for herself, doctors eventually found several small blood clots in her lungs and administered life-saving treatment. Sadly, hundreds of women each year are not as fortunate.
To advance health equity for all and address implicit bias and structural racism in health care, Excellus BlueCross BlueShield appointed Gina Cuyler, MD, as vice president of health equity and community investments in November 2021. A graduate of the University of Rochester School of Medicine and Dentistry, Dr. Cuyler is a board-certified internal medicine physician who is passionate about improving health outcomes for everyone. Using a cross-functional, data-driven approach, Dr. Cuyler is working to embed health equity across every aspect of Excellus BlueCross BlueShield’s organization and addressing maternal health disparities is one of her top priorities.
Maternal health is the continuum of care that includes the time before pregnancy, pregnancy itself, and one year postpartum. The health conditions of mothers before pregnancy impacts maternal and child health outcomes and, under Dr. Cuyler’s leadership, Excellus BCBS is working to address negative outcomes such as severe maternal morbidity (SMM). The U.S. Centers for Disease Control and Prevention defines SMM as “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” The many drivers of maternal health include socioeconomic status, access to maternal health providers, geographic location, structural racism and implicit provider bias.
“Women of color are particularly at risk for negative maternal health outcomes independent of socioeconomic status, education or other factors. A Black mother with a college education is likely to have worse maternal health outcomes than a White mother without a college education,” notes Dr. Cuyler. A Blue Cross Blue Shield Association study on racial and ethnic disparities in maternal health revealed that preexisting health conditions, such as hypertension, diabetes and asthma, strongly correlate with higher SMM. The study found that Black women ages 35-44 have a 66% higher rate of SMM and are more likely to suffer pregnancy-related complications than white women in the same age range. The U.S. maternal mortality rate is the highest among similarly developed countries, with 17.4 deaths per 100,000 live births. “With all of the wealth, resources and knowledge in our country, we must do better,” says Dr. Cuyler.
Maternal health affects more than just mothers and their babies, but the community as a whole. When pregnancy complications arise, premature birth, low birth weight and prolonged stays in neonatal intensive care units increase as well. There is a societal cost when maternal health is not a top priority, says Dr. Cuyler. From the family members who suffer the loss of their loved one, to employers and co-workers bearing the burden when a parent has to take time off to care for their child, or worse, when an employee dies from pregnancy complications, maternal health affects families, businesses and communities. “It has a comprehensive impact on everyone,” Dr. Cuyler says, “we all bear the cost.”
Dr. Cuyler is addressing the drivers of higher SMM in a data-driven way. “Health equity work requires metrics,” Dr. Cuyler says, “you can’t manage what you can’t measure and you can’t measure what you can’t define.” After creating a health equity strategy for Excellus BCBS, Dr. Cuyler brought on health equity data analysts to help her capture and analyze the metrics required to determine actionable solutions. Collecting robust data is also dependent on identifying the attributes of the people in underserved communities, and that requires patients to submit complete attribute information so they can be identified appropriately in the data.
The COVID-19 pandemic highlighted health disparities in our nation, especially for people of color and, Dr. Cuyler says, the narrative surrounding health equity is expanding. Aligning with the health equity frameworks of New York state, the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services, Excellus BCBS is advancing equity along with quality in the healthcare arena. Dr. Cuyler’s goal is to embed health equity in every part of the organization. “Health equity is an enterprise initiative and we work in a cross-functional manner. I have deputized an army of ambassadors in our organization to understand how their work contributes to being able to provide meaningful health outcomes and improve health equity for all.”
In October 2022, Excellus BCBS announced the first round of recipients of Member and Community Health Improvement (MACHI) grants to address SMM and related health equity issues in upstate New York. Eight non-profit organizations were selected within the Health Plan’s 39-county service area to share $1 million in grant funding over the next three years. “We assembled a cross-functional, interdisciplinary team to determine these grant recipients to address depression, education, safety, lactation and homelessness,” says Dr. Cuyler, “we are very excited about the opportunity to impact at multiple points of the maternal health care continuum.” Additionally, Excellus BCBS provides bias in maternal health training to health providers in the region through a partnership with the March of Dimes.
Health equity is personal for Dr. Cuyler. Born in Panama, she immigrated to the United States with her mother when she was a young girl (her father died when she was two years old). Dr. Cuyler recounts an experience at a public hospital in New York City after her mother burned herself cooking. For over 16 hours, they sat in “a room full of black and brown people in agony. I realized that for some people, the health care system isn’t always equitable or kind,” Dr. Cuyler recalls.
Dr. Cuyler states that many patients have better health outcomes when a provider shares the same attributes of a patient population (race, gender, language, cultural background), and thus, she co-founded the Black Physicians Network of Greater Rochester, an organization whose mission is to reduce health disparities and improve the health of the community by increasing the number of black physicians. “I do believe it helps for you to see a physician that came from the same circumstances,” says Dr. Cuyler, “I am passionate about mentoring because I didn’t have a mentor. I had to figure everything out the hard way.”
Dr. Cuyler wants every single person in the United States to have access to equitable healthcare and, to achieve that, she wants every person to ask themselves what they are doing to advance health equity in their sphere of influence. For those in the health care community, it is important to build trust. “Today we are committed to doing better not just for some but for everyone. We want to help patients feel engaged, educated and empowered, and for health care providers to understand how important they are in advancing health equity,” says Dr. Cuyler, “everyone has a role to play.”
Health equity is when each person has a chance to have optimal health. – Gina Cuyler, MD
At the end of the day, we have to make sure we are making progress in maternal health equity because the stakes are so high. – Gina Cuyler, MD